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    <p style="font-family: 宋体; font-size: 15.75pt; text-align: Center">
      <label style="font-family: 宋体; font-size: 15.75pt; font-weight: bold; text-align: Center"
        >云南城投昆明妇女儿童医院</label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt; text-align: Center">
      <label style="font-family: 宋体; font-size: 15.75pt; font-weight: bold">麻醉知情同意书</label>
    </p>
  </div>

  <div
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    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">姓名:</label>
      <field
        tabindex="0"
        id="姓名"
        name="姓名"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="姓名"
        >姓名</field
      >
      <label style="font-family: 仿宋; font-size: 14.25pt"> 性别:</label>
      <field
        tabindex="0"
        id="性别"
        name="性别"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="性别"
        >性别</field
      >
      <label style="font-family: 仿宋; font-size: 14.25pt"> 年龄:</label>
      <field
        tabindex="0"
        id="年龄"
        name="年龄"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="年龄"
        >年龄</field
      >
      <label style="font-family: 仿宋; font-size: 14.25pt"> 门诊号:</label>
      <field
        tabindex="0"
        id="病历号"
        name="病历号"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="病历号"
        data-code=""
        validate="false"
        format=""
        >病历号</field
      >&nbsp;<label style="font-family: 仿宋; font-size: 14.25pt">科室:</label>
      <field
        tabindex="0"
        id="科室"
        name="科室"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="{科室}"
        >科室</field
      >&nbsp;<label style="font-family: 仿宋; font-size: 14.25pt"> 床号:</label>
      <field
        tabindex="0"
        id="日期"
        name="日期"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="床号"
        >床号</field
      >
    </p>
    <p style="font-family: 仿宋; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">诊断:</label>
      <field
        tabindex="0"
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        name="诊断"
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        type="Text"
        value=""
        title="诊断"
        data-code=""
        validate="false"
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        >诊断</field
      >&nbsp;<label style="font-family: 仿宋; font-size: 14.25pt">执行检查手术: </label>
      <field
        tabindex="0"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="执行手术"
        >执行手术</field
      >
      <label style="font-family: 仿宋; font-size: 14.25pt"> 体重: </label>
      <field
        tabindex="0"
        id="体重"
        name="体重"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title="体重"
        data-code=""
        validate="false"
        format="alpha"
        >{体重}</field
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      <label style="font-family: 仿宋; font-size: 14.25pt">k</label>
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >任何麻醉均有风险性，在根据患者病情，切实做好麻醉前准备并按操作规范认真做好麻醉工 作及范防范措施情况下，仍有可能发生以下难以避免的麻醉意外及并发症：</label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >1、根据麻醉需要及操作规范，遵照《中华人民共和国药典》要求使用各种麻醉药物和输液用液体 后，由于患者体制原因，出现输液反应，过敏、高敏反应，致热源反应等，甚至导致过敏性休 克、呼吸心跳停止； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >2、麻醉期间可能发生恶心、呕吐、返流误吸、喉水肿、喉痉挛，导致气道梗阻，窒息；</label
      >
      <label style="font-family: 宋体; font-size: 14.25pt"> </label>
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >3、呼吸抑制甚至短暂呼吸暂停；血压下降；心率减慢；严重者可能发生心跳呼吸骤停； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >4、因麻醉诱发原有隐患匿性疾病发作，如哮喘、癫痫、心脑血管意外等； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >5、因抢救需要气管插管，可能损伤患者口唇、牙齿、引起反流误吸、气道痉挛、窒息； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">6、其他难以预料的并发症及意外。 </label>
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">麻醉后注意事项 </label>
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">1、麻醉结束后2小时内不要饮水、进食； </label>
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >2、接受麻醉后当天，不能驾驶机动车，骑自行车及电动车，不能经行精细操作工作和高空作业； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >3、麻醉结束后，请在医院观察休息一段时间，待麻醉医生认可后，方能离开； </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >我们将以良好的医德医术为患者实行麻醉，力争将麻醉风险降低到最低程度，保障患者安全。上 述情况以对患者及家属说明，并对患者方提出的问题作了详细的解答，经慎重考虑，患者及家属 对麻醉可能出现的风险表示充分的理解，同意要求实行麻醉，签字为证：</label
      >
    </p>
    <p style="undefined" id="" title="患者签名">
      <label style="font-family: 仿宋; font-size: 14.25pt">患者本人签字</label
      ><img
        type="sign"
        alt="双击手写签名"
        style="width: 120px; height: 40px"
        draggable="false"
        id="patient-sign"
        name="patient-sign"
        title=""
      /><span style="font-size: 14.25pt"> 签字时间_____年___月___日___ 时____分 </span>
    </p>
    <p style="font-family: 仿宋; font-size: 14.25pt">
      <label style="font-family: 仿宋; font-size: 14.25pt">患者家属签字</label
      ><img
        type="sign"
        alt="双击手写签名"
        style="width: 120px; height: 40px"
        draggable="false"
        id="patient-family-sign"
        name="patient-family-sign"
        title="家属签名"
      /><span style="font-size: 14.25pt">与患者关系_____</span>
    </p>
    <p style="font-family: 仿宋; font-size: 14.25pt; text-align: Center"><br /></p>
    <p style="font-family: 宋体; font-size: 12pt; text-align: Right">
      <label style="font-family: 仿宋; font-size: 14.25pt"
        >麻醉医师签名： <img
          readonly
          style="width: 120px; height: 80px"
          type="sign"
          alt="医生签名"
          id="doctor-sign"
          name="doctor-sign"
          title="医生签名"
        />      </label
      >
    </p>
    <p style="font-family: 宋体; font-size: 12pt; text-align: Right">
      <field
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        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
        value=""
        title=""
      ></field>
      <label style="font-family: 仿宋; font-size: 14.25pt">年</label>
      <field
        tabindex="0"
        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
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      ></field>
      <label style="font-family: 仿宋; font-size: 14.25pt">月</label>
      <field
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        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
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      ></field>
      <label style="font-family: 仿宋; font-size: 14.25pt">日</label>
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        class="blank"
        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
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      <label style="font-family: 仿宋; font-size: 14.25pt">时</label>
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        style="font-family: 仿宋; font-size: 14.25pt"
        contenteditable="true"
        type="Text"
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      ></field>
      <label style="font-family: 仿宋; font-size: 14.25pt">分</label>
      <label style="font-family: 仿宋; font-size: 14.25pt; text-align: Right"> </label>
    </p>
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